One of the last voices Catherine Terry ever heard was her daughter, telling her that everything was going to be OK.
She was wrong. Terry died of a heart attack inside her central Hamilton apartment on July 10, waiting for paramedics to save her.
No one in her family knew it then, but Terry had called for help while the city was in the midst of a "code zero" event. That's when there is only one — or even zero — ambulances across the service's entire fleet available for a call.
- 'Patients will literally die': Times when no ambulances available on the rise
- Pressure on Hamilton paramedics rising as city's senior population grows
It's a crisis that's happening more frequently, leaving Hamiltonians in medical distress at risk of having no one available to help them when they need it most.
Now, the Terry family wants accountability, and is trying to figure out why it took almost half an hour for an ambulance to reach the 71-year-old mother and grandmother as she lay dying on her apartment floor.
'There's no regard for human life at this point. It's something that could be fixed, but it's not.'
- Alison Terry, daughter
"I believe if they had just been on time, she would have been revived and helped, and she'd be sitting with us right now," said her daughter, Paige Sutherland, through tears.
"But she's not. She's sitting in a box on my sister's table, that I have to deliver to her home in Scotland next year, and spread her ashes over the cliffs of Ayr. That's what I get to do."
Mario Posteraro, president of Ontario Public Service Employees Union Local 256, which represents Hamilton paramedics, predicted earlier this month that someone would die during a code zero event. He says local EMS workers are pushed to the limit, and without additional resources, more people will die.
"I'm not surprised. I think we'll see more of this," he said. "Unless there is an investment in this service … we'll continuously face stories like this."
Just eight months into the year, there have already been more code zero incidents in Hamilton than all of last year — and that number is getting worse instead of better.
Dreams of a better life in Canada
Terry first came to Canada from Scotland at age 18, funding the trip with her pageant winnings as "Ayr's Bonnie Lass of 1964." She married Bill Terry — a professional wrestler under the name Kurt Von Hess — in March 1965.
"For her to win this and go to Canada was what any young girl dreamed of back then to escape poverty," Sutherland says.
The two raised a family and Bill died of a heart attack in 1999. As she got older, Terry developed some health issues, though she did not have a history of heart problems, her children say.
'I said, "Mom, the ambulance is on the way, you're going to be OK.''' - Paige Sutherland
Terry lived on her own and had a Lifeline Medical Alert System — patients call for help by pushing a button on a wristband, even if they can't speak.
Hospital records viewed by CBC News show an emergency call was placed through Terry's Lifeline system at 9:36 p.m. on July 10. The Ministry of Health's dispatch centre classified the incident as a fall, not an emergency cardiac incident, paramedic officials say. She couldn't talk, so they were dealing with limited information.
Sutherland, who was also alerted by Lifeline, says she started calling her mother around 9:40 p.m. "She kept answering but not talking," she said. "Five times I called her. She was answering the phone. She was conscious. That's what's killing me.
"I said, 'Mom, the ambulance is on the way, you're going to be OK.' I just told her that everything was going to be fine."
But no ambulance was coming. Every single one was busy.
Firefighters first on scene
Paramedic chief Michael Sanderson confirmed the service was dealing with a code zero for about four hours starting at about 8:50 p.m. on July 10.
By 9:54 p.m. — 18 minutes after the initial call — firefighters had entered Terry's apartment and discovered her heart wasn't beating. They started CPR, and that's when the call was upgraded to urgent, Sanderson said.
An ambulance arrived at Terry's building at 10 p.m., and paramedics finally got inside her apartment at 10:04 p.m. — 28 minutes after Lifeline first called for help. In an interview, Sanderson pointed out that paramedics were on scene within six minutes of the call being upgraded, though they didn't actually reach her for another four.
According to the U.S. Brain Injury Foundation, irreversible brain damage starts to occur within five minutes of oxygen deprivation to the brain.
The provincial benchmark for arrival times that paramedics strive to hit on non-emergency calls is 25 minutes. For the most urgent calls requiring resuscitation, it's six minutes.
Posteraro says a nearly 30-minute response time is "totally unacceptable in any regard." He was also emphatic in saying that if paramedics had been able to get there quicker and assess the situation, the chances of survival for a patient like Terry would be much higher.
"Heart attacks are so time sensitive. If they'd just gotten there earlier, who knows?" said Terry's other daughter, Alison.
"Nobody here is being held accountable. Not the city. Not the province. No one."
Code zeroes on the rise
Code zero incidents were even more common in Hamilton a few years ago. In 2013, there were 242 of them in Hamilton. That number dropped to 44 in 2015, but has been creeping back up.
City statistics show that to the end of August, Hamilton had 79 code zero incidents, 19 more than all of last year. Posteraro says multiple code zeroes have occurred in the city this week alone.
So what's causing the problem? Paramedics say it's a surge in call volumes for help, and problems with increasingly long wait times offloading patients in local hospitals.
The paramedic service's annual report for 2016 shows a seven per cent demand increase in 911 calls in Hamilton last year, coupled with a cumulative increase of 35 per cent over the past seven years.
"This rate of service demand increase is higher than community population growth can explain and must be attributed to an increasingly aging population, socio-economic factors, and an increasing reliance on care in the community or home for patients with complex health care histories or issues," Sanderson wrote in the report.
It also says while seniors only represent about 16 per cent of the city's population, they accounted for 45 per cent of the demand on ambulances last year.
Census data shows people over 65 are the fastest-growing population that paramedics serve. By 2021, provincial projections show, 25 per cent of Ontario will be in that age group.
Hamilton has a higher than average percentage of people aged 65 and older, according to the latest census data.
Hospital cuts make it worse
Then there are offloading times at hospitals, which the city says directly influence code zeroes.
The province recommends 90 per cent of patients be offloaded from an ambulance within 30 minutes of reaching a hospital, the paramedic service report says. The Ontario average last December was 46 minutes.
In Hamilton, it took a lot longer. In December 2016, it took 107 minutes for patients to be offloaded at Hamilton General, 112 minutes at Juravinski, at 91 minutes at St. Joe's.
City spokesperson Allison Jones says every code zero event this year is associated with a day where the paramedic service had 10 or more offload delays longer than two hours.
Hospitals largely attribute these delays to overcrowding. As an example, on July 25 of this year, Hamilton Health Sciences (HHS) was operating at 109.9 per cent occupancy. Its occupancy has been, on average, over 105 per cent since October 2016.
While hospitals are slammed, funds are scarce. HSS says it needs to cut $20 million from its budget by the end of March, while St. Joseph's Healthcare needs to cut $7 million.
Posteraro hopes decision makers are paying attention to the ugly reality of health care cuts. "Decision makers have to come to the table to decisively fix the problem," he said.
'No regard for human life'
Sanderson said he couldn't address whether he would ask city council for more money to hire paramedics.
"I have to make sure I go through council on that," he said.
For their part, the Terry family wants to see something done, to make sure what has happened to them doesn't happen again.
"There's no regard for human life at this point," Alison Terry said.
"It's something that could be fixed, but it's not."